Dr Adrian Palfreeman and Professor Martin Fisher (left) explain how achieving NICE accreditation for BHIVA has helped improve guidance development and processes

The NICE Accreditation Programme assesses the processes used to produce guidance and advice, and 54 of these processes have been accredited since 2009.

To achieve NICE accreditation, guidance producers are assessed on a case-by-case basis, against criteria in six domains, based on the internationally recognised Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument for developing robust guidance.1 Accredited organisations can display the NICE Accreditation Statement on guidance that is produced to the approved process (see Box 1)—this gives healthcare and social care staff confidence that the information has been developed to a quality process, along with reassurance that it will help them deliver the highest standards of patient care.

The British HIV Association (BHIVA) has received NICE accreditation for all guidance released since 2012, most recently for its antiretroviral therapy guideline (available at: www.bhiva.org/documents/Guidelines/Treatment/2012/hiv1029_2.pdf).2 In this article, BHIVA explains the reasons for applying for accreditation, their experiences of the process, and the resulting benefits.

Box 1: NICE Accreditation

NICE accredited

Reasons to seek accreditation

BHIVA is encouraging other guidance producers to work towards achieving NICE accreditation because, from its own experience, this will result in more robust, credible, and evidence-based guidelines. Dr Adrian Palfreeman and Professor Martin Fisher explain: ‘BHIVA acts as a national advisory body to professionals and other organisations and provides a national platform for HIV care. We publish a range of clinical guidelines, covering the treatment and management of HIV infection and associated co-morbidities, to help promote and monitor standards of care.

We decided to aim for NICE accreditation as we could see that a number of challenges lay ahead of us in terms of the validity of our current guidelines. We realised that being able to show that our guidelines were produced in line with the rigorous processes recognised by NICE would be very useful when negotiating with commissioners, and others. NICE accreditation would demonstrate that our guidelines are robust and evidence-based.

In current and future economic climates, prescribing choices are likely to be challenged, and rightly so. If BHIVA members and clinicians can prescribe in accordance with guidelines bearing the NICE stamp of approval, they should avoid challenges about their prescribing choices.

Guideline development

Relatively few physicians, in a number of specialties, prescribe antiretroviral therapy. The vast majority of these physicians belong to BHIVA, so it seemed entirely reasonable for these British experts to write the antiretroviral guidelines. BHIVA already had a guidance development process in place, but the NICE Accreditation Programme provided an excellent opportunity to examine and considerably improve on it. NICE provided excellent support throughout the application process, adding value and quality. We are also grateful to people in other accredited organisations who shared some of their experiences with us. Indeed, we were able to look at other guidance development manuals and processes (sometimes our own processes seemed better, sometimes not). By examining and comparing these approaches to guidance, we were able to select examples from other organisations that would best meet our needs.

Benefits of training

We learned many lessons from the application process. The training on information appraisal was particularly valuable, and well received by the guideline development writing committee. This training also helped lend further credibility to the guidelines, as a robust methodology needs to be applied when appraising and assessing the evidence on which they are based. This is useful when comparing them with other international guidelines, which differ in their recommendations, and where the methodology is less clear. Getting clinicians on board regarding the conflict of interest aspect of the document was also interesting, and very useful.

NICE accreditation results in a more robust, more credible, and more evidence-based guideline—we are confident that the accredited process BHIVA has in place for gathering, appraising, and assessing the evidence is far more robust than the process for some other guidelines.3

A further benefit resulting from NICE accreditation was the change it brought to the reviewing process for BHIVA guidelines. Prior to NICE accreditation, our guidelines were sent out for external peer review to one or two reviewers whose prime task was normally to review our journal articles (for HIV Medicine). This meant that guidelines were sometimes heavily amended or even rewritten on the opinion of just one individual—who might not even be practising in the UK. With the new system, we have incorporated this external peer review into the guideline development process, so that once reviews are complete and all other comments received, the writing committee can agree and sign off the final version of the guideline for publication.

Outcomes and responses

Following accreditation, our guidance has been better appreciated by our international colleagues, who see the degree of rigour that has gone into guideline development.3 Most importantly, patient groups such as i-base4 and aidsmap5 know that the process is as rigorous as it can be. Indeed, Simon Collins, Treatment Advocate at HIV i-base, has said: ‘BHIVA has for many years included community advocates on the writing groups for all guidelines. This involvement is essential. The move for BHIVA to use processes that have been accredited by NICE should both improve the transparency over the final recommendations and increase clarity over the quality of the evidence on which they are based. This strengthens the quality of the final guidelines and ultimately it is patients who benefit.

BHIVA now has a very clear implementation policy, which the NICE process encourages. We have produced patient-friendly versions of our guidelines and we are developing slide kits for clinicians, pharmacists, and nurses to promote dissemination and encourage implementation of the new guidelines. We have also developed a ‘best of five questions’ on the BHIVA website (see www.bhiva.org/ELearning.aspx6), which can be used to gain continuing professional development (CPD) points—another method of increasing guideline dissemination and implementation. So there are a number of ways in which we can try to ensure the guidelines are implemented, and that patients receive the most up-to-date care.

Martin Fisher, says: ‘When I presented the BHIVA antiretroviral guidelines at an American conference, our guidelines were congratulated on, for the rigour of their development. We would advise any other organisation thinking of applying for accreditation to look at the NICE accreditation website (www.nice.org.uk/accreditation), to attend at least one public meeting of the Accreditation Advisory Committee, and to speak to another accredited group, to find out more.’

Further information can be found at www.nice.org.uk/accreditation

  1. AGREE website. Introduction to AGREE II. www.agreetrust.org/about-agree/introduction (accessed 25 March 2013).
  2. British HIV Association. Guidelines for the treatment of HIV-1 positive adults with antiretroviral therapy 2012. HIV Medicine 2012; 13 (Suppl. 2): 1–85.
  3. Sabin C, Cooper D, Collins S, Schechter M. Rating evidence in treatment guidelines: a case example of when to initiate combination antiretroviral therapy (cART) in HIV-positive asymptomatic persons. AIDS 2 April 2013 (published ahead of print).
  4. HIV i-base website. www.i-base.info (accessed 25 March 2013).
  5. NAM Publications. aidsmap website. www.aidsmap.com (accessed 25 March 2013).
  6. British HIV Association website. www.bhiva.org/ELearning.aspx (accessed 5 April 2013). G